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Table 2 Country-recommended priority actions for addressing common bottlenecks to scaling up antenatal corticosteroids.

From: Antenatal corticosteroids for management of preterm birth: a multi-country analysis of health system bottlenecks and potential solutions

Health system building block

Sub-category

Priority actions

Leadership and governance

Policy and guidelines

• Develop, update and disseminate the national policy on prevention and management of preterm labour; this should include policy on ACS use

• Advocate for newborn health to be made as a priority

• Develop national clinical protocols and guidelines on management of preterm labour

Health financing

Funding/budget allocation

• Increase funding / budget allocation for newborn care

• Advocate and lobby for more funding from partners in newborn health

 

Cost of antenatal corticosteroids

• Assess financial implications and develop financial policy for supplies and services to deliver this intervention to beneficiaries

• Include antenatal corticosteroids as part of the free MNCH policy

• Scale up obstetric kits by including relevant newborn drugs such as antenatal corticosteroids

Health workforce

Policy restriction for prescription and administration

• Authorise all skilled births attendants to prescribe and administer ACS

 

Job descriptions/job aids

• Develop and disseminate job aids

 

Shortage of qualified staff

• Recruit and train competent health providers

• Develop an electronic database to track training activities and identify needs

• Ensure staffing norms are in line with WHO recommendations

 

Competency and training

• Strengthen competency based pre-service and in-service training, and on job training to capture use of ACS by health providers for fetal lung maturation

• Include ACS training in skilled birth attendant evaluation

Health service delivery

Service availability

• Develop and disseminate national guidelines in health facilities

• Establish follow-up visits to monitor availability and use of ACS in all health facilities

 

Quality of care

• Establish a supportive supervision and mentoring mechanism with a reward system;

• Regular integrated monitoring visits to ensure compliance to protocols;

• Integrate ACS use in clinical audits and reviews;

 

Referral systems

• Involve all stakeholders to improve infrastructure for timely referral (road network)

• Build district-level capacity to monitor appropriate use of ambulances and ensure adequate maintenance

Essential medical products and technologies

Procurement policy

• Include ACS in national essential medicines list with appropriate indication (fetal lung maturation)

 

Drug availability

• Develop and disseminate policy in health facilities to enhance procurement

 

Logistics management information systems (LMIS)

• Estimate needs based on number/estimate of preterm birth load at health facilities

• Build staff capacity for logistics management

Health information system

Data collection and reporting

• Define indicator(s) for tracking ACS use and incorporate into national system

• Strengthen monitoring mechanisms such as regular monitoring and evaluation visits, documentation through use of program data.

• Conduct regular review meetings on data management at all levels

Community ownership and participation

Knowledge / awareness

• Conduct integrated community maternal and newborn education and campaigns in local languages

• Improve community awareness on newborn health by adding newborn information to maternal awareness documents, campaigns, media, etc.

 

Community participation / engagement

• Strengthen community leaders and male involvement through innovative approaches;

• Strengthen functioning of existing community units with nationwide community awareness initiatives on newborn health

• Health facilities to come up with innovative ways of involving men e.g. set aside time for couples during antenatal visits and time for adolescents

 

Demand for preterm birth care

• Scale up tribal empowerment project to address socio-cultural barriers to newborn care

• Utilise community radio and mobile applications